Integumentary System

Skin and Glands Hair Nails

HistoryIntegumentary System

Previous skin history Changes in pigmentation Moles, any changes Excessive dryness or moisture Itching (pruritus) Excessive bruising Rash or lesions Medications Hair loss Nail changes

Skin

Color General pigmentation (skin tone)

Vitiligo-absence of pigment Freckles

Small, flat macules, brown Mole

Proliferation of melanocytes, macular or papular

Tan to brown Birthmarks

Tan to brown in color

Widespread color changes

Pallor (white)Unnatural paleness d/t constriction of

cutaneous vesselsAnemia, Shock

Erythema (redness)Excess blood in superficial capillaries d/t

vasodilatationFever or localized inflammation

Cyanosis (blue)Decreased perfusionShock, heart failure, bronchitis, congenital ht

dx Jaundice (yellow)

Excess bilirubin in the bloodCirrhosis, sickle-cell anemia, transfusion

reactions

Temperature and Moisture

Temperature Use back of hand Hypothermia

CoolnessSurgery, immobilized extremity, shock

HyperthermiaIncreased metabolic rate

Hyperthyroidism, fever, heavy exercise, trauma, infection, sunburn

Moisture Diaphoresis- excessive perspiration Dehydration-dry, parched and cracked lips

Texture and Thickness

Texture Character of the skin’s surface. It is not normally

uniform throughout. Elbow vs. cheek Hyperthyroidism-velvet Hypothyroidism-rough,dry, and flaky

Thickness Thin over body Thick over palms & soles

Mobility & Turgor

Mobility = rise of skin Turgor = return of skin, the elasticity of skin.

It may be diminished by edema or dehydration. The skin normally loses elasticity with age Elderly – chest Infants – abdomen Adult/teen - arms

Vascularity or Bruising

Vascularity or Bruising Petechiae

Tiny purple or redspots d/t minute hemorrhages in the dermis

Cherry angiomasSmall, smooth, raised red dots on trunk in

adults over 30 Bruising (ecchymosis) Tattoos

Hair

2 Types Terminal Hair

Long, coarse, thick. Found on scalp, axilla and pubic areas. Vellus Hair

Small, soft, tiny hairs. Covering entire body except hands, soles of feet and penis

Color Texture Distribution Condition of scalp

Common Hair Abnormalities

Hirsutism Male pattern growth in women, especially the

face Alopecia - Balding Excessively oily hair

Associated with androgen hormone stimulation

Dry brittle hair Associated with aging and excessive use

of shampoo, etc Dry coarse discolored hair

Suspect poor nutrition Decreased hair on the extremities

Arterial insufficiency

Nails

Shape & contour Normally transparent, smooth, convex with white tips

Strength/Thickness Can be a nutritional indicator

Color – determined by vascularity of nailbed Linear pigmentation

Pigment bands normal in dark skinned individuals Leukonychia striata

Markings from trauma, picking at cuticles Capillary refill Clubbing

Note if bite their nails If nails are dirty, clean Well trimmed or groomed